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Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics

BACKGROUND: Granulomatous tubulointerstitial nephritis (GIN) is common due to infections, drugs or sarcoidosis. However, the cause is often difficult to establish and the studies are limited. We studied the etiology of GIN and compared the clinical and histological features and outcome in different...

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Autores principales: Agrawal, Vinita, Kaul, Anupama, Prasad, Narayan, Sharma, Kusum, Agarwal, Vikas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581389/
https://www.ncbi.nlm.nih.gov/pubmed/26413276
http://dx.doi.org/10.1093/ckj/sfv071
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author Agrawal, Vinita
Kaul, Anupama
Prasad, Narayan
Sharma, Kusum
Agarwal, Vikas
author_facet Agrawal, Vinita
Kaul, Anupama
Prasad, Narayan
Sharma, Kusum
Agarwal, Vikas
author_sort Agrawal, Vinita
collection PubMed
description BACKGROUND: Granulomatous tubulointerstitial nephritis (GIN) is common due to infections, drugs or sarcoidosis. However, the cause is often difficult to establish and the studies are limited. We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India. METHODS: Renaö biopsies from GIN cases diagnosed from January 2004 to April 2014 were retrieved. Stain for acid fast bacilli was performed in all biopsies. Etiological diagnosis was based on clinical features, extra-renal manifestations, radiology, history of drug intake and demonstration of infective agent. Tissue PCR for tubercular DNA was performed in seven biopsies. RESULTS: Seventeen GIN patients [mean age 35 ± 15 years; males 11] were identified. Tuberculosis was the commonest etiology followed by idiopathic, sarcoidosis and fungal. Both tuberculosis and sarcoidosis patients presented with subnephrotic proteinuria and raised serum creatinine. Acid fast bacilli were demonstrated in 1/9 and necrosis was demonstrated in 3/9 granulomas in tuberculosis. Tissue PCR for tubercular DNA was positive in six TB patients and negative in one sarcoidosis patient. Patients responded well to appropriate therapy. CONCLUSION: Etiological diagnosis of GIN is essential for timely and appropriate therapy. Tuberculosis is the commonest etiology (53%) in the tropics. Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN. Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN.
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spelling pubmed-45813892015-09-25 Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics Agrawal, Vinita Kaul, Anupama Prasad, Narayan Sharma, Kusum Agarwal, Vikas Clin Kidney J Contents BACKGROUND: Granulomatous tubulointerstitial nephritis (GIN) is common due to infections, drugs or sarcoidosis. However, the cause is often difficult to establish and the studies are limited. We studied the etiology of GIN and compared the clinical and histological features and outcome in different etiologies at a tertiary care center in North India. METHODS: Renaö biopsies from GIN cases diagnosed from January 2004 to April 2014 were retrieved. Stain for acid fast bacilli was performed in all biopsies. Etiological diagnosis was based on clinical features, extra-renal manifestations, radiology, history of drug intake and demonstration of infective agent. Tissue PCR for tubercular DNA was performed in seven biopsies. RESULTS: Seventeen GIN patients [mean age 35 ± 15 years; males 11] were identified. Tuberculosis was the commonest etiology followed by idiopathic, sarcoidosis and fungal. Both tuberculosis and sarcoidosis patients presented with subnephrotic proteinuria and raised serum creatinine. Acid fast bacilli were demonstrated in 1/9 and necrosis was demonstrated in 3/9 granulomas in tuberculosis. Tissue PCR for tubercular DNA was positive in six TB patients and negative in one sarcoidosis patient. Patients responded well to appropriate therapy. CONCLUSION: Etiological diagnosis of GIN is essential for timely and appropriate therapy. Tuberculosis is the commonest etiology (53%) in the tropics. Necrosis in granuloma, demonstration of acid fast bacilli, blood interferon gamma release assay and urine culture is not sensitive for the diagnosis of tuberculosis in GIN. Our findings suggest that tissue PCR for tuberculosis performed in an appropriate clinical setting is useful in the diagnostic evaluation of GIN. Oxford University Press 2015-10 2015-08-19 /pmc/articles/PMC4581389/ /pubmed/26413276 http://dx.doi.org/10.1093/ckj/sfv071 Text en © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Contents
Agrawal, Vinita
Kaul, Anupama
Prasad, Narayan
Sharma, Kusum
Agarwal, Vikas
Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
title Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
title_full Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
title_fullStr Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
title_full_unstemmed Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
title_short Etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
title_sort etiological diagnosis of granulomatous tubulointerstitial nephritis in the tropics
topic Contents
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581389/
https://www.ncbi.nlm.nih.gov/pubmed/26413276
http://dx.doi.org/10.1093/ckj/sfv071
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